Tài liệu Handbook of Long-Term Care Administration and Policy pdf

Handbook of
Long-Term Care
Administration
and Policy
CRC_AU5327_FM.indd iCRC_AU5327_FM.indd i 2/22/2008 10:07:30 AM2/22/2008 10:07:30 AM
PUBLIC ADMINISTRATION AND PUBLIC POLICY
A Comprehensive Publication Program
EDITOR-IN-CHIEF
EVAN M. BERMAN
Huey McElveen Distinguished Professor
Louisiana State University
Public Administration Institute
Baton Rouge, Louisiana
Founding Editor
JACK RABIN
Professor of Public Administration and Public Policy
The Pennsylvania State UniversityHarrisburg
School of Public Affairs
Middletown, Pennsylvania
1.
Public Administration as a Developing Discipline,
Robert T. Golembiewski
2.
Comparative National Policies on Health Care,
Milton I. Roemer, M.D.
3.
Exclusionary Injustice: The Problem of Illegally Obtained Evidence,
Steven R. Schlesinger
5.
Organization Development in Public Administration,

edited by
Robert T. Golembiewski and William B. Eddy
7.
Approaches to Planned Change,
Robert T. Golembiewski
8.
Program Evaluation at HEW,
edited by James G. Abert
9.
The States and the Metropolis,
Patricia S. Florestano
and Vincent L. Marando
11.
Changing Bureaucracies: Understanding the Organization before
Selecting the Approach,
William A. Medina
12.
Handbook on Public Budgeting and Financial Management,
edited by
Jack Rabin and Thomas D. Lynch
15.
Handbook on Public Personnel Administration and Labor Relations,
edited by Jack Rabin, Thomas Vocino, W. Bartley Hildreth,
and Gerald J. Miller
19.
Handbook of Organization Management,
edited by William B. Eddy
22.
Politics and Administration: Woodrow Wilson and American Public
Administration,

edited by Jack Rabin and James S. Bowman
23.
Making and Managing Policy: Formulation, Analysis, Evaluation,
edited by G. Ronald Gilbert
25.
Decision Making in the Public Sector,
edited by Lloyd G. Nigro
26.
Managing Administration,
edited by Jack Rabin, Samuel Humes,
and Brian S. Morgan
27.
Public Personnel Update,
edited by Michael Cohen
and Robert T. Golembiewski
CRC_AU5327_FM.indd iiCRC_AU5327_FM.indd ii 2/22/2008 10:07:31 AM2/22/2008 10:07:31 AM
28.
State and Local Government Administration,
edited by Jack Rabin
and Don Dodd
29.
Public Administration: A Bibliographic Guide to the Literature,
Howard E. McCurdy
31.
Handbook of Information Resource Management,
edited by Jack Rabin
and Edward M. Jackowski
32.
Public Administration in Developed Democracies: A Comparative Study,
edited by Donald C. Rowat

33.
The Politics of Terrorism: Third Edition,
edited by Michael Stohl
34.
Handbook on Human Services Administration,
edited by Jack Rabin
and Marcia B. Steinhauer
36.
Ethics for Bureaucrats: An Essay on Law and Values, Second Edition,
John A. Rohr
37.
The Guide to the Foundations of Public Administration,
Daniel W. Martin
39.
Terrorism and Emergency Management: Policy and Administration,
William L. Waugh, Jr.
40.
Organizational Behavior and Public Management: Second Edition,
Michael L. Vasu, Debra W. Stewart, and G. David Garson
43.
Government Financial Management Theory,
Gerald J. Miller
46.
Handbook of Public Budgeting
, edited by Jack Rabin
49.
Handbook of Court Administration and Management
, edited by
Steven W. Hays and Cole Blease Graham, Jr.
50.

Handbook of Comparative Public Budgeting and Financial Management
,
edited by Thomas D. Lynch and Lawrence L. Martin
53.
Encyclopedia of Policy Studies: Second Edition,
edited by
Stuart S. Nagel
54.
Handbook of Regulation and Administrative Law,
edited by
David H. Rosenbloom and Richard D. Schwartz
55.
Handbook of Bureaucracy,
edited by Ali Farazmand
56.
Handbook of Public Sector Labor Relations
, edited by Jack Rabin,
Thomas Vocino, W. Bartley Hildreth, and Gerald J. Miller
57.
Practical Public Management
, Robert T. Golembiewski
58.
Handbook of Public Personnel Administration
, edited by Jack Rabin,
Thomas Vocino, W. Bartley Hildreth, and Gerald J. Miller
60.
Handbook of Debt Management
, edited by Gerald J. Miller
61.
Public Administration and Law: Second Edition

, David H. Rosenbloom
and Rosemary O'Leary
62.
Handbook of Local Government Administration
, edited by
John J. Gargan
63.
Handbook of Administrative Communication
, edited by
James L. Garnett and Alexander Kouzmin
64.
Public Budgeting and Finance: Fourth Edition,
edited by
Robert T. Golembiewski and Jack Rabin
67.
Handbook of Public Finance
, edited by Fred Thompson
and Mark T. Green
68.
Organizational Behavior and Public Management: Third Edition,
Michael L. Vasu, Debra W. Stewart, and G. David Garson
69.
Handbook of Economic Development
, edited by Kuotsai Tom Liou
70.
Handbook of Health Administration and Policy
, edited by
Anne Osborne Kilpatrick and James A. Johnson
CRC_AU5327_FM.indd iiiCRC_AU5327_FM.indd iii 2/22/2008 10:07:31 AM2/22/2008 10:07:31 AM
72.

Handbook on Taxation
, edited by W. Bartley Hildreth
and James A. Richardson
73
. Handbook of Comparative Public Administration in the Asia-Pacific
Basin
, edited by Hoi-kwok Wong and Hon S. Chan
74
. Handbook of Global Environmental Policy and Administration,
edited by
Dennis L. Soden and Brent S. Steel
75
. Handbook of State Government Administration,
edited by
John J. Gargan
76.
Handbook of Global Legal Policy,
edited by Stuart S. Nagel
78.
Handbook of Global Economic Policy,
edited by Stuart S. Nagel
79
. Handbook of Strategic Management: Second Edition,
edited by
Jack Rabin, Gerald J. Miller, and W. Bartley Hildreth
80.
Handbook of Global International Policy,
edited by Stuart S. Nagel
81.
Handbook of Organizational Consultation: Second Edition,

edited by
Robert T. Golembiewski
82.
Handbook of Global Political Policy,
edited by Stuart S. Nagel
83.
Handbook of Global Technology Policy,
edited by Stuart S. Nagel
84.
Handbook of Criminal Justice Administration
, edited by
M. A. DuPont-Morales, Michael K. Hooper, and Judy H. Schmidt
85.
Labor Relations in the Public Sector: Third Edition
, edited by
Richard C. Kearney
86.
Handbook of Administrative Ethics: Second Edition,
edited by
Terry L. Cooper
87.
Handbook of Organizational Behavior: Second Edition
, edited by
Robert T. Golembiewski
88.
Handbook of Global Social Policy,
edited by Stuart S. Nagel
and Amy Robb
89.
Public Administration: A Comparative Perspective, Sixth Edition,

Ferrel Heady
90.
Handbook of Public Quality Management
, edited by Ronald J. Stupak
and Peter M. Leitner
91.
Handbook of Public Management Practice and Reform
, edited by
Kuotsai Tom Liou
93.
Handbook of Crisis and Emergency Management
, edited by
Ali Farazmand
94.
Handbook of Comparative and Development Public Administration:
Second Edition,
edited by Ali Farazmand
95.
Financial Planning and Management in Public Organizations
,
Alan Walter Steiss and Emeka O. Cyprian Nwagwu
96.
Handbook of International Health Care Systems,
edited by Khi V. Thai,
Edward T. Wimberley, and Sharon M. McManus
97.
Handbook of Monetary Policy,
edited by Jack Rabin
and Glenn L. Stevens
98.

Handbook of Fiscal Policy,
edited by Jack Rabin and Glenn L. Stevens
99.
Public Administration: An Interdisciplinary Critical Analysis,
edited by
Eran Vigoda
100.
Ironies in Organizational Development: Second Edition, Revised
and Expanded,
edited by Robert T. Golembiewski
101.
Science and Technology of Terrorism and Counterterrorism
, edited by
Tushar K. Ghosh, Mark A. Prelas, Dabir S. Viswanath,
and Sudarshan K. Loyalka
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102.
Strategic Management for Public and Nonprofit Organizations
,
Alan Walter Steiss
103.
Case Studies in Public Budgeting and Financial Management:
Second Edition,
edited by Aman Khan and W. Bartley Hildreth
104.
Handbook of Conflict Management,
edited by William J. Pammer, Jr.
and Jerri Killian
105.
Chaos Organization and Disaster Management,

Alan Kirschenbaum
106.
Handbook of Gay, Lesbian, Bisexual, and Transgender Administration
and Policy,
edited by Wallace Swan
107.
Public Productivity Handbook: Second Edition,
edited by Marc Holzer
108.
Handbook of Developmental Policy Studies,
edited by
Gedeon M. Mudacumura, Desta Mebratu and M. Shamsul Haque
109.
Bioterrorism in Medical and Healthcare Administration,
Laure Paquette
110.
International Public Policy and Management: Policy Learning Beyond
Regional, Cultural, and Political Boundaries,
edited by David Levi-Faur
and Eran Vigoda-Gadot
111.
Handbook of Public Information Systems, Second Edition,
edited by
G. David Garson
112.
Handbook of Public Sector Economics,
edited by Donijo Robbins
113.
Handbook of Public Administration and Policy in the European Union,
edited by M. Peter van der Hoek

114.
Nonproliferation Issues for Weapons of Mass Destruction,
Mark A. Prelas and Michael S. Peck
115.
Common Ground, Common Future: Moral Agency in Public
Administration, Professions, and Citizenship
, Charles Garofalo
and Dean Geuras
116.
Handbook of Organization Theory and Management: The Philosophical
Approach, Second Edition,
edited by Thomas D. Lynch
and Peter L. Cruise
117.
International Development Governance,
edited by
Ahmed Shafiqul Huque and Habib Zafarullah
118.
Sustainable Development Policy and Administration,
edited by
Gedeon M. Mudacumura, Desta Mebratu, and M. Shamsul Haque
119.
Public Financial Management,
edited by Howard A. Frank
120.
Handbook of Juvenile Justice: Theory and Practice,
edited by
Barbara Sims and Pamela Preston
121.
Emerging Infectious Diseases and the Threat to Occupational Health

in the U.S. and Canada,
edited by William Charney
122.
Handbook of Technology Management in Public Administration,
edited by David Greisler and Ronald J. Stupak
123.
Handbook of Decision Making,
124.
Handbook of Public Administration, Third Edition,
edited by Jack Rabin,
W. Bartley Hildreth, and Gerald J. Miller
125.
Handbook of Public Policy Analysis,
edited by Frank Fischer,
Gerald J. Miller, and Mara S. Sidney
126.
Elements of Effective Governance: Measurement, Accountability
and Participation,
edited by Kathe Callahan
127.
American Public Service: Radical Reform and the Merit System,
edited by James S. Bowman and Jonathan P. West
128.
Handbook of Transportation Policy and Administration,
edited by
Jeremy Plant
edited by Göktug Morçöl
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129.
The Art and Practice of Court Administration,

Alexander B. Aikman
130.
Handbook of Globalization, Governance, and Public Administration,
edited by Ali Farazmand and Jack Pinkowski
131.
Handbook of Globalization and the Environment,
edited by Khi V. Thai,
Dianne Rahm, and Jerrell D. Coggburn
132.
Personnel Management in Government: Politics and Process,
Sixth Edition,
Norma M. Riccucci and Katherine C. Naff
133.
Handbook of Police Administration,
edited by Jim Ruiz
and Don Hummer
134.
Handbook of Research Methods in Public Administration,
Second Edition,
edited by Kaifeng Yang and Gerald J. Miller
135.
Social and Economic Control of Alcohol: The 21st Amendment
in the 21st Century,
edited by Carole L. Jurkiewicz
and Murphy J. Painter
136.
Government Public Relations: A Reader,
edited by Mordecai Lee
137.
Handbook of Military Administration,

edited by Jeffrey A. Weber
and Johan Eliasson
138.
Disaster Management Handbook,
edited by Jack Pinkowski
139.
Homeland Security Handbook,
edited by Jack Pinkowski
140.
Health Capital and Sustainable Socioeconomic Development,
edited by
Patricia A. Cholewka and Mitra M. Motlagh
141.
Handbook of Administrative Reform: An International Perspective,
edited by Jerri Killian and Niklas Eklund
142.
Government Budget Forecasting: Theory and Practice,
edited by
Jinping Sun and Thomas D. Lynch
143.
Handbook of Long-Term Care Administration and Policy,
edited by
Cynthia Massie Mara and Laura Olson
Available Electronically
Principles and Practices of Public Administration
, edited by
Jack Rabin, Robert F. Munzenrider, and Sherrie M. Bartell
PublicADMINISTRATION
netBASE
CRC_AU5327_FM.indd viCRC_AU5327_FM.indd vi 2/22/2008 10:07:32 AM2/22/2008 10:07:32 AM

Edited by
Cynthia Massie Mara
Pennsylvania State University
Middletown, Pennsylvania, U.S.A.
Laura Katz Olson
Lehigh University
Bethlehem, Pennsylvania, U.S.A.
CRC Press is an imprint of the
Taylor & Francis Group, an informa business
Boca Raton London New York
Handbook of
Long-Term Care
Administration
and Policy
CRC_AU5327_FM.indd viiCRC_AU5327_FM.indd vii 2/22/2008 10:07:32 AM2/22/2008 10:07:32 AM
CRC Press
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CRC_AU5327_FM.indd viiiCRC_AU5327_FM.indd viii 2/22/2008 10:07:33 AM2/22/2008 10:07:33 AM
Dedication
To our children, Shannon, Heather, and Alix, that the long-term
care system may be transformed by the time you may need it.
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xi
Contents
Foreword xv
Preface x vii
Acknowledgments xix
Editors xxi
Cont r ibutors x xii i

PART I: SETTING THE STAGE
1.
History, Concepts, and Overview 3
CYNTHIA MASSIE MARA
2. Public Perceptions of Long-Term Care 19
LAURA KATZ OLSON
3. Looking for Care in All the Wrong Places 35
DEBORAH STONE
4.  e Medicalization of Long-Term Care: Weighing the Risks 47
COLLEEN M. GROGAN
PART II: PROVIDING AND RECEIVING CARE
5.
Older Long-Term Care Recipients 73
MEGAN E. McCUTCHEON AND WILLIAM J. McAULEY
6. Younger Individuals with Disabilities: Compatibility
of Long-Term Care and Independent Living 85
ARTHUR W. BLASER
7. Informal Caregivers and Caregiving: Living at Home
with Personal Care 105
SHARON M. KEIGHER
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xii Ⅲ Contents
8. Trends and Challenges in Building a Twenty-First Century
Long-Term Care Workforce 133
EDWARD ALAN MILLER AND VINCENT MOR
9.  e Role and Responsibilities of the Medical Director
and the Attending Physician in Long-Term Care Facilities 157
DANIEL SWAGERTY
PART III: FOCUSING ON SERVICES
10.

Long-Term Care Services, Care Coordination,
and the Continuum of Care 173
MEGAN E. McCUTCHEON AND WILLIAM J. McAULEY
11. Legal Issues Related to Long-Term Care: Elder Law,
Estate Planning, and Asset Protection 197
JAN L. BROWN
12. Long-Term Care Housing Trends: Past and Present 221
SHANNON M. CHANCE
PART IV: ADMINISTERING CARE
13.
Long-Term Care Governance and Administration:
A Historical Perspective 241
STEPHEN E. PROCTOR
14. Improving the Quality of Long-Term Care
with Better Information 267
VINCENT MOR
15. Long-Term Care Housing Types and Design 293
SHANNON M. CHANCE
PART V: POLICY MAKING AND FINANCING
16.
Long-Term Care Politics and Policy 319
WILLIAM WEISSERT
17. Geriatric Mental Health Policy: Impact on Service Delivery
and Directions for Eff ecting Change 339
BRADLEY E. KARLIN AND MICHAEL DUFFY
18. Private Financing for Long-Term Care 363
GALEN H. SMITH AND WILLIAM P. BRANDON
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Contents Ⅲ xiii
19. Public Financing of Long-Term Care 387

STEPHEN A. STEMKOWSKI AND WILLIAM P. BRANDON
PART VI: LOOKING AHEAD
20.
Focal Points of Change 415
CYNTHIA MASSIE MARA
Index 425
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xv
Foreword
Long-term care has been and remains the distant cousin of health policy. News-
papers are full of commentary on what 2008 presidential candidates have to say
about “universal health coverage,” the new expression for what used to be called
national health insurance. However, one would be hard-pressed to describe what
any of them think about long-term care.  e discussion of how America is aging
touches on familiar themes: the pressure on the Medicare budget, the implications
for Social Security pensions, and whether the savings or the sports behavior of baby
boomers is adequate for their future. It is hard to avoid endless comments on which
diet should be followed for healthy living, whether lead or benzene poisoning is
to become the asbestos story of the twenty-fi rst century, or whether the impact of
a growing proportion of those above 65 years should prompt smaller apartments
or more handrails in modern bathrooms. But one would look in vain for straight-
forward discussion of long-term care—its likely scale, its fi nancing, its connection
to Medicaid spending, or its impact on family caregivers, let alone what other coun-
tries have done in this area of social policy.
 is handbook brought together by Mara and Olson is precisely directed
toward that relative neglect. As writing has increased about the administration
and policy struggles in medical care, comparable attention has not been given to
long-term care.  is handbook presumes that the sharp increases forecasted in
older Americans for the next three or four decades warrant extended discussion.

What training will administrators in this sphere of social and medical life require?
What can we learn from the experience of other industrial democracies about the
fi nancing of care for the frail? If all of us have a modest probability of needing such
care, does social insurance make sense? What are the prospects for private fi nanc-
ing, or for the continued role of Medicaid as a funder of last resort?  e realities of
both providing and receiving care are too readily masked. How many Americans,
for example, know anything about the scale of nonelderly recipients of long-term
care?  e list of neglected topics, as the table of contents reveals, is long.
 at is the justifi cation of gathering such a wide range of policy and administra-
tive writers to contribute to this handbook.  e editors have for years been writing,
teaching, and conducting research in long-term care.  ey have made presentations
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xvi Ⅲ Foreword
on the state, national, and international levels.  ey have also organized panels and
lectures related to long-term care.  is is the product of their scholarly search for
the complete range of commentaries about the world of American long-term care,
now and in the future. It is a welcome addition to the literature.
Ted R. Marmor
School of Management
Yale University
New Haven, Connecticut
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xvii
Preface
 e fastest growing part of the population is the 85-years-and-older cohort.  e
baby boomers have already begun to enter their 60s and the need for long-term care
will escalate as they age.  e growing requirement for services, with its associated
opportunities and challenges, necessitates the presence of additional skilled long-
term care administrators and policy makers. Moreover, long-term care administra-
tion is undergoing a process of professionalism similar to the one that took place

decades ago in hospital administration.  is evolution heightens the need for eff ec-
tive preparation for administrators and policy makers.
 is text grew out of my long-standing interest in long-term care. During varied
work experiences, I have seen that:
A person, even one with diminishing abilities, could remain safely at home if
there is adequate support from family and the community.
Mistreatment of nursing home residents existed as well as conditions that put
their lives in jeopardy.
Apathy was apparent on the part of some offi cials whose job it was to ensure
the delivery of safe, adequate long-term care.
Isolation was often experienced during extended hospital stays by people who
were dying;* their call lights tended to be answered only after considerable
delay, and their requests to talk about the seriousness of their illness were
frequently ignored.
Public policy, and its many modifi cations, had the potential to improve the
long-term care system and the lives of the people it served.
Positive changes in institutional and home and community-based care could
be made through both the public and private sectors.
Individuals needing long-term care comprised a diverse population.
* Extended hospital stays took place before the implementation of a prospective payment system
for hospitals. More about this change in hospital reimbursement can be found in the chapters
on the fi nancing of long-term care.
Ⅲ
Ⅲ
Ⅲ
Ⅲ
Ⅲ
Ⅲ
Ⅲ
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xviii Ⅲ Preface
Advocates for younger and older people with chronic illnesses or disabili-
ties often saw themselves in competition for the same resources and resisted
cooperating to improve the lives of people of all ages who need assistance
with daily activities.
My experiences have also shown me the relationship between the quality of an
organization’s administration and that of the services provided.  e need for edu-
cated, prepared administrators and policy makers is abundantly clear.  is hand-
book is designed as an instructive tool for the education of individuals planning to
work in long-term care. It contains a wide range of information they will need as
they provide leadership in the long-term care arena.  is handbook is also intended
as a reference for individuals already employed in this fi eld.
Laura Katz Olson’s deep interest in aging and long-term care prompted me
to ask her to serve as the coeditor of this text. I was pleased that she accepted the
invitation.
Cynthia Massie Mara
Ⅲ
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xix
Acknowledgments
 e preparation of this handbook has involved our collaboration with many tal-
ented individuals in the fi eld of long-term care. First, we express great appreciation
to the authors for writing about and sharing their particular areas of expertise.
 rough their work, each of them participates in the preparation of leaders for the
long-term care system.
 e editors would like to thank the following individuals for their review of and
comments on various materials: Mary Brundage DeLashmutt, Susan Donckers,
and Elizabeth Revell.  e continual support and encouragement provided by Kay
Morhard is also very much appreciated.
 ree former and one current graduate student in the Penn State’s Master

of Health Administration program are to be particularly thanked. Nidhi Daga
and Supraja Vija conducted literature reviews and provided much assistance at
the beginning of the project. Deb Kephart, who is now participating in a long-
term care research project, also provided helpful input. Graduate student Patsy
Taylor-Moore, who has years of experience in the long-term care endeavors of state
government, is especially thanked for applying her many skills as work on the
handbook was brought to completion.
We acknowledge with gratitude the many clients whom we have met during our
various work experiences in long-term care.  ey have been our teachers.
Cynthia Massie Mara
Laura Katz Olson
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xxi
Editors
Cynthia Massie Mara is Associate Professor of Health Care Administration and
Policy at  e Pennsylvania State University, where she has worked since 1994. She is
the coordinator of the Master of Health Administration program and the developer
and coordinator of the Graduate Certifi cate Program in Long-Term Care Admin-
istration and Policy. She serves as adjunct Associate Professor of Management and
Health Systems at  e Pennsylvania State University College of Medicine.
Dr. Mara’s research interests include health and long-term care administration
and policy, the long-term care system, aging and disability, and organizational
theory. Her current research focuses on assisting state government in planning
for Medicaid-funded long-term care services and expenditures as the demands on
these public programs continue to expand. Other studies on the state level have
addressed programs fi nanced through the Older Americans Act. Dr. Mara has
conducted research for the U.S. Department of Justice on developing strategies
to address long-term care needs in prison systems. She has been an invited grant
reviewer for the U.S. Department of Health and Human Services Administration

on Aging and the National Institutes of Health.
Dr. Mara has authored a number of professional articles; has made presenta-
tions at meetings of state, national, and international organizations; and serves as
the long-term care editor of an academic journal and an editorial board member
for two additional journals. She organized the Aging Politics and Policy Group
at the American Political Science Association meetings and serves as president of
the organization. Dr. Mara was the founder and executive director of a Medicare-
and Medicaid-funded not-for-profi t hospice organization. She has worked on the
U.S. Senate Subcommittee on Aging and for the New York City Department for
the Aging. Earlier, as an Assistant Professor of Nursing, she worked with two col-
leagues to establish a baccalaureate nursing program.
Laura Katz Olson has been Professor of Political Science at Lehigh University since
1974 and chair of the department since 2003. She has published six books:  e
Political Economy of Aging:  e State, Private Power and Social Welfare; Aging and
Public Policy:  e Politics of Growing Old in America;  e Graying of the World: Who
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xxii Ⅲ Editors
Will Take Care of the Frail Elderly; Age through Ethnic Lenses: Caring for the Elderly
in a Multicultural Society;  e Not So Golden Years: Caregiving, the Frail Elderly and
the Long-Term Care Establishment; and Heart Sounds (her fi rst novel). Currently,
she is working on a book project titled  e Politics of Medicaid: Stakeholders and
Welfare Medicine.
Dr. Olson has published widely in the fi eld of aging and women’s studies. Her
articles address topics such as pensions, Social Security, problems of older women,
and long-term care. She has been a scholar at the Social Security Administration,
a gerontological fellow, and a Fulbright scholar. She has also lectured throughout
Pennsylvania on Social Security, Medicare, and long-term care policies funded by
the Pennsylvania Humanities Council. Dr. Olson is on the editorial board of the
Journal of Aging Studies and New Political Science.
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xxiii
Arthur W. Blaser, Ph.D.
Department of Political Science
Chapman University
Orange, California
William P. Brandon, Ph.D., M.P.H.
Department of Political Science
University of North Carolina
at Charlotte
Charlotte, North Carolina
Jan L. Brown, J.D.
Jan L. Brown & Associates
Harrisburg, Pennsylvania
Shannon M. Chance, AIA
Department of Architecture
Hampton University
Hampton, Virginia
Michael Duff y, Ph.D., ABPP
Department of Educational
Psychology
Texas A&M University
College Station, Texas
Colleen M. Grogan, Ph.D.
School of Social Service
Administration
University of Chicago
Chicago, Illinois
Bradley E. Karlin, Ph.D.
Offi ce of Mental Health
Services

Veterans Administration Central
Offi ce
Washington, DC
Sharon M. Keigher, Ph.D., ACSW
Helen Bader School of Social Welfare
University of Wisconsin—
Milwaukee
Milwaukee, Wisconsin
Cynthia Massie Mara, Ph.D.
School of Public Aff airs
 e Pennsylvania State University
Middletown, Pennsylvania
and
College of Medicine
 e Pennsylvania State University
Hershey, Pennsylvania
William J. McAuley, Ph.D.
Department of Communication
George Mason University
Fairfax, Virginia
Megan E. McCutcheon, M.A.
Department of Communication
George Mason University
Fairfax, Virginia
Contributors
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xxiv Ⅲ Contributors
Edward Alan Miller, Ph.D.
Departments of Political
Science and Community

Health Center, and
Centers for Public Policy
and Gerontology and
Health Care Research
Brown University
Providence, Rhode Island
Vincent Mor, Ph.D.
Department of Community
Health Center, and Center
for Gerontology and
Health Care Research
Brown University
Providence, Rhode Island
Laura Katz Olson, Ph.D.
Department of Political
Science and Public
Policy
Lehigh University
Allentown, Pennsylvania
Stephen E. Proctor
President and CEO
Presbyterian Homes, Inc.
Camp Hill, Pennsylvania
Galen H. Smith III, M.H.A. and
Doctoral Candidate
Public Policy Program
University of North Carolina
at Charlotte
Charlotte, North Carolina
Stephen A. Stemkowski, M.H.A.

and Doctoral Candidate
Public Policy Program
University of North Carolina
at Charlotte
Charlotte, North Carolina
Deborah Stone, Ph.D.
Department of Government
Dartmouth College
Hanover, New Hampshire
Daniel Swagerty, M.D., M.P.H.
Landon Center on Aging
Department of Family Medicine
University of Kansas
Kansas City, Kansas
and
American Medical Directors
Association
Columbia, Maryland
William Weissert, Ph.D.
Department of Political Science
Florida State University
Tallahassee, Florida
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